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Anti-circumcision activists (self-branded “intactivists”) claim that circumcision is a mark of slavery—specifically, that slave-owners used circumcision as a means of subjugating their slaves. Some of their memes specifically claim that white American men forced circumcision on their African American slaves. Nothing could be further from the truth! In reality, throughout history, slaves and subjugated races have either been required NOT to circumcise, or have been left alone. I could not find evidence that circumcision was forced on slaves.

Before America

Let’s step back a bit. Some intactivist sources will start out by specifically mentioning Egypt and claiming that Egyptians circumcised their slaves by force, that circumcision was a mark of slavery. But this is completely false.

In Ancient Egypt, it was recognized that there were hygiene and health benefits to being circumcised. It seemed to be primarily a practice of the middle class and wealthy, with nearly all pharaohs circumcised, and very few slaves (except the Jews, who practiced circumcision before becoming slaves to the Egyptians). Of course, there were certainly exceptions to every rule. But an important point to make is that the intactivist claim that circumcision was a mark of slavery in Egypt is just not true. In reality, nearly all of the pharaohs were circumcised, and those who chose not to undergo the procedure apparently did so to show their spiritual and political superiority over the priests, who performed all circumcisions [1]. If it was predominately a practice of the wealthy and the pharaohs, how could it be a mark of slavery?

Maccabeean Revolt

In fact, ironically, the opposite is typically true in human history. Circumcision has generally been prohibited of subjugated races rather than required. For example, the Jews were forced to stop circumcising when the white Greeks ruled over them. Although they initially stopped circumcising and circumcised in secret, their ultimate reaction was to fight back in the Maccabeean Revolt, and that battle is commemorated in Hanukkah [2]. As another example, the advanced civilizations of America, such as the Aztecs, practiced circumcision. When the white Spanish conquistadores instituted a systematic destruction of the indigenous cultures, part of their method was to prohibit circumcision, which is why Hispanics to this day do not circumcise—because white man took away their right to do so back in the 1500s [1].

In other words, rather than being forced to circumcise, underdog races have generally been left alone or forced NOT to circumcise.

Why Did White Americans Circumcise?

Before we can understand why circumcision might have been recommended for or required of African Americans, we must first understand what Americans thought of circumcision. Why did Americans, Europeans, and others start circumcising in recent centuries?

King Louis XVI

Phimosis has been recognized as a serious foreskin problem since ancient times—in fact, the Greek god Priapus, ironically a god of fertility, is depicted as having severe phimosis, which would have limited his own fertility. In the 1770s, French King Louis XVI suffered from phimosis so severe that he was infertile for the first 8 years of his marriage. After his brother-in-law, Austrian Emperor Joseph II, convinced him to get circumcised, he promptly fathered three children. This may have been the start of circumcision among European royalty, with apparently most of European royalty favoring circumcision, though it remained uncommon or rare among the common people [1].

As far back as the 1820s, it was recognized that circumcision reduced the risk of gonorrhea* [3]. It was also recognized by the 1850s to reduce the risk of syphilis [4] and since at least 1904, if not before, that circumcision reduces the risk of penile cancer [5]. Furthermore, during the 1800s, bacteria were identified as causes of disease, and hygiene was identified as a way to prevent bacterial infections, but bathing was still rare (a weekly event at best), and so hygiene with a foreskin was very difficult, as demonstrated by numerous medical publications on the subject in those days. Surgery was also becoming safer during this time period, so it was no longer seen as a last-ditch effort against death but rather as something one might do for preventive health. They also thought a circumcised penis performed better sexually. So the combination of recognized health benefits, poor hygiene, and a belief that circumcised men were sexually superior, along with advances in surgical technique that made surgery a much safer proposition, led to a gradual rise in the circumcision rate [1].

anti-masturbation device

Around that same time, some uncircumcised men proposed that it is impossible for circumcised men to masturbate. (Allow us a pause for laughter.) Circumcised scholars proved them wrong. Personally, I would have loved to see that scholarly convention. Nonetheless, for this and other reasons, a few people suggested that circumcision might prevent masturbation, which was at that time thought to cause mental illness. However, most sources promoting circumcision made no mention of masturbation, and most sources demonizing masturbation made no mention of circumcision, so this was obviously not a widely-, much less universally-, accepted theory [1].

The experiences of American, Canadian, Australian, and other soldiers in WWI and WWII—where uncircumcised soldiers developed horrific infections and required circumcision—led to a sudden, dramatic rise in the circumcision rate that mere concerns about health and hygiene could not affect [6]. Thus, in the U.S., England, Australia, New Zealand, and Canada, circumcision became popular. By 1949, the circumcision rates in the U.S. vs. England were 45% vs. 50% for poor boys and 94% vs. 85% for rich boys. In Australia and New Zealand, there were no such class distinctions, and by 1950, circumcision was nearly universal for whites [1, 9].

However, circumcision has always been less common for the poor and minority races. So how do intactivists get the idea that circumcision became a mark of slavery for African Americans?

Circumcision and African Americans

Now on to the question of circumcision in American black slavery.

All of the intactivist articles I’ve read fail to provide any pre-Civil War sources. In other words, they provide absolutely no references to African American circumcision before slavery was abolished. So I’m not sure how they can claim that it was a mark of black slavery committed against blacks by whites. Then again, intactivist sources are known to lie shamelessly…

On the other hand, after the Civil War, there were several publications or speeches suggesting that forcibly castrating black men would protect vulnerable white women from rape. At the same time that uncircumcised men thought circumcised men couldn’t masturbate, they also thought circumcised men were less likely to commit rape. So at least one person suggested that circumcision would be a kinder and more humane method than castration, especially given the proven health benefits of circumcision, as there were no known health benefits to castration.

Furthermore, there were discussions in the early 1900s about the rising rate of syphilis among the black population, and because it was known that circumcision lowered the risk of syphilis and was already recommended to whites for that reason, it made sense to recommend it to blacks as well. In this case, it was not suggested that they should force it on black men; it simply said, “As regards personal prophylaxis, all male babies should be circumcised,” which is similar language to that in discussions of white circumcision of the time period. There were also many other recommendations, including condoms (“prophylactic packages”), addressing cocaine and alcohol addiction (since substance use was involved in many rapes), home studies to prevent overcrowding, curfews, making syphilis a legally reportable condition (as it is today, and as were smallpox, measles, pertussis, and other communicable diseases in those days), provisions for the medical care of children born with syphilis, improving care in-hospital (see quote below), improving care in clinics, and more. Altogether, there was exactly one sentence on circumcision as a preventive, and it took up less than four lines of text; the other recommendations took up 26 sentences and over 80 lines of text** [7]. Note also that this was in the days before antibiotics, so there was no really effective treatment for syphilis; thus, most energy was expended on prevention.

“The way that syphilis is treated in the average ward or outpatient department is a disgrace. [….] If a factory turned out goods in the slipshod way that the average hospital hands out syphilitic medication, it would soon go to the wall.” [7]

But again, there is no evidence that circumcision was actually forced on African Americans as a routine measure, either as a mark of slavery or as a means of racial subjugation.

In short, intactivists have drummed up a number of articles that were apparently in the minority opinion and which were never followed-through on. In these articles or speeches, various racists and non-racists alleged that circumcision would benefit the African American male (or others) for a variety of reasons. The racist reasons included preventing black rape of white women. The non-racist reasons included prevention of STDs. The racist ones rarely called for compulsory castration and circumcision of African American males. The non-racist ones called for recommending circumcision to African American males or parents. Speeches on the subject were even given at African American conventions, such as the Coloured Physicians’ Association in 1889 [8]. However, intactivists have failed to present evidence that male circumcision was forced on African Americans at any point, much less that it was a mark of African American slavery.

Conclusion

In conclusion, I could find no evidence that circumcision has ever (much less predominately) in the history of mankind been a mark of slavery. Rather, slaves and subjugated races have been forced by white man not to circumcise in more than one instance. While there were certainly propositions that circumcision should be recommended for the prevention of various ills (for both racist and non-racist reasons) in the African American male, I can find no evidence that it was ever forced on African Americans. Rather, it seems mostly to have been withheld from them due to the difference in socioeconomic status, as circumcision was predominately a practice of the wealthy and African Americans have long been economically disadvantaged and oppressed.

~~

FOOTNOTES

*Modern research indicates that might be false, but this was considered a medical fact back then.

**I actually was quite surprised by this article. The author went to great lengths to emphasize that there are many African Americans who have made well for themselves and are physicians, lawyers, etc., and that there is no concern about syphilis among this group; that many European cities have higher illegitimate birth rates than do African Americans, so it’s not a uniquely African American problem at all; and that many white children have deplorable morals compared to African American children, etc., and almost apologetically reiterated that nonetheless, African Americans were for some reason more affected by syphilis than were whites. Until reading this article, I was under the impression that political correctness did not exist in the early 1900s! He proved me wrong. Nonetheless, intactivists contend that this article is an example of stereotyping. It seems they didn’t bother to read the entire article.

[3] Abernethy, J. (1828). The Consequences of Gonorrhoea. Lectures on Anatomy, Surgery and Pathology: Including Observations on the nature and treatment of local diseases; delivered at St. Bartholomew’s and Christ’s Hospitals, Chapter XXII (pp. 315-316). 163, The Strand, London: James Bulcock.

[4] Hutchinson, J. (1855). On the influence of circumcision in preventing syphilis. Medical Times Gazette, 2:542-543.

In short: No. Not only is there NO evidence that forced retraction DOES cause phimosis, there is actually POSITIVE evidence–cataloged on intactivists’ own websites–that forced retraction DOES NOT cause phimosis.

What are Adhesions?

The foreskin is naturally stuck to the glans by what we call “adhesions.” Virtually 100% of uncut boys have adhesions that prevent the foreskin from retracting. In fact, because circumcision often doesn’t remove the entire foreskin, adhesions occur in 45% [Van Howe, 2001] to 71% [Ponsky et al, 2000] of circumcised boys as well. Breaking the adhesions by retracting the foreskin before it’s ready—called “forced retraction”—is very painful and has no known medical benefits. In order to circumcise, these adhesions must be broken, but the boy receives highly effective numbing medicine beforehand [Shockley & Rickett, 2011]. However, there’s no numbing medicine in day-to-day life, and there’s no evidence that forced retraction is beneficial to the boy’s health. So… cut or uncut… don’t do it.

Why Do We Forcibly Retract?

Intactivists claim that Americans retract the foreskin because of cultural ignorance of proper care of the foreskin due to unfamiliarity with the foreskin thanks to the relatively low number of uncut males in our society—in other words, cultural ignorance. However, this argument is false. In reality, retraction of the foreskin even in infants is a hold-over from early 1900s medicine which has not yet been fully dropped, and this practice was common in Europe, as demonstrated by a landmark British Medical Journal article (archived in intactivists’ own websites in full text format) wherein the (anti-circumcision) author stated, “mothers and nurses are often instructed to draw the child’s foreskin back regularly” [Gairdner, 1949, p. 1435]. At that time, the American newborn circumcision rate was very low—lower, in fact, than the British newborn circumcision rate. Furthermore, in spite of the vast majority of American boys being circumcised, most physicians don’t know how to properly care for the circumcised penis, either, and thus retract the skin, breaking the adhesions, and causing pain [Ponsky et al, 2000]. It’s not cultural ignorance. It’s prehistoric medicine.

Does Forced Retraction Cause Medical Problems?

Intactivists claim that forced retraction causes tiny, microscopic tears in the delicate inner skin of the foreskin, causing infection and scarring. The scarring then allegedly results in phimosis, for which the treatment is often circumcision. So it’s considered ironic that “most” medically-necessary circumcisions are necessary only because the foreskin was not properly cared for in the first place. Intactivists make this claim as a matter of fact, so I believed it was actually based in fact. However, what I found was that their own sources say the exact opposite.

I wanted to have a primary source for articles like this, rather than a heavily biased secondary or tertiary source, so I searched all of the intactivist websites for all their articles on forced retraction in order to farm their resources. For their theory that forced retraction causes infections and scarring, they almost exclusively cited tertiary sources—predominately, old pediatric textbooks. (For those who don’t know, textbooks often don’t differentiate between theory and proven fact, so a textbook should never be taken as an authoritative source.) However, one article in Psychology Today actually provided a tertiary resource that was published in a medical journal. So I used the anti-circumcision online Circumcision Resource Library to look it up.

A Psychology Today Blog post, which originated from another blog post by a Ms. Cannon, instructs parents not to retract the foreskin and states that forcibly retracting the foreskin “tears the foreskin and the tissue… that connects it to the head of the penis, leading to scarring and infection” [Nervaez, 2011]. It provided no reference for the claim that retraction causes scarring, but for the instruction not to retract, it provides as its reference a 2002 article, which states, “Parents should be educated to avoid forcible retraction of the prepuce; the tearing that may result could lead to fibrosis [scarring] and subsequent true phimosis…” [Camille, Ramsay, & Wiener, 2002] For this claim, it provided a 1998 reference, which I followed, and which states, “True pathologic phimosis occurs when fibrosis, induration and scarring occur in the tip of the foreskin usually secondary to inflammation or trauma” [Simpson & Baraclough, 1998]. For this claim, it provided a 1980 reference [Rickwood et al, 1980], which I followed, and which turned out to be the primary source I’d been looking for.

The primary source was a study of phimosis in boys aged 4-11 years undergoing a medically-necessary circumcision for scarring on the tips of their foreskins, resulting in pathological phimosis. Cross-sections of their foreskins were compared to cross-sections of the foreskins of non-phimotic boys circumcised for religious reasons. Their histories of infection, forced retraction, and other foreskin or penile issues (even their fathers’ histories of phimosis in search of a potential genetic basis) were also gathered and compared. The authors discussed three previous theories from the 1950s-1960s of the causes of phimosis, that it is caused by forced retraction [Twistington Higgins, Williams, & Ellison Nash, 1951], or by repeated bacterial infection [Campbell, 1951], or by irritation caused by ammonia (present in urine) [Robarts, 1962]. Ultimately, they could find no correlation between phimosis and any of these theoretical causes and concluded, “There was little to support the contention that the condition is caused by trauma, or by ammoniacal [urine-caused] or bacterial inflammation of the prepuce…” and “Our data do not support previous contentions that it is due to forcible retraction, ammonia dermatitis or recurrent balanoposthitis [infection of the glans and foreskin].”

Interestingly, what they did find was that balanitis xerotica obliterans (BXO) was present in almost every case (20 of 21 specimens) [Rickwood et al, 1980]. This was similar to another British study by the same author, which found that 84% of pathological phimosis specimens had BXO [Shankar & Rickwood, 1999]. As I’ll discuss further in a later post, we don’t know the cause of BXO and therefore don’t know how to prevent it, and the treatment is typically circumcision. Perhaps if certain intactivists could get off their high horses and stop fallaciously insisting that the only cause of circumcision is forced retraction (due to its falsely alleged causal relationship with phimosis), we could get some real research done to find out what causes BXO, realizing that BXO may be the primary—or even the only—cause of phimosis. Then, perhaps we could prevent phimosis from ever occurring, and thereby prevent the most common cause of medically-necessary circumcisions. Personally, I believe this theory has significant merit because it has even been demonstrated in women, where the cause of clitoral phimosis (where the clitoral hood is too tight) has been demonstrated to be caused primarily by BXO and secondarily by surgical trauma [Flynn et al, 2015].

At any rate, the very interesting, but not completely surprising, part is that these secondary sources I found cited this primary source as evidence that phimosis is caused by trauma, specifically forced retraction, yet the primary source they’re citing says the exact opposite. In other words, the authors either didn’t check the sources they were citing or were intentionally lying.

Conclusion

So to sum up, there’s actually no evidence that forced retraction causes any medical problems whatsoever.

However…. That being said… It’s still painful to forcefully retract a boy, cut or uncut, so it’s probably best to just leave it alone.

There’s an issue in conversations about male circumcision today. Well, there are a lot of issues, such as the complete shutting down of opposing viewpoints and slinging of ad hominems and cyber bullying. But the one out of the dozens of issues that I want to address in this post is terminology.

The United Nations’ official term “Female Genital Mutilation” (FGM) refers to the cultural practice that involves removing part or all of a girl or woman’s clitoris, clitoral hood, and labia, and sometimes sewing her vagina closed [1] (see Footnote 1). It’s a horrific practice, and so “mutilation” seems fitting. However, they discovered that when discussing the practice with natives and trying to educate them about how harmful the practice really is, the term “mutilation” is so emotionally-charged that it tends to shut down conversation entirely and do more harm than good in advancing their anti-FGM cause (see Footnote 2). Thus, when conversing with natives and educating them about the harms of the practice, the WHO advocates the use of the emotionally neutral and anatomically accurate term “Female Genital Cutting” (FGC). [1]

A very similar thing is happening in online conversations about circumcision. I would like us to advance toward a better understanding of each other and an improved ability to communicate effectively, and this may be one small part of that.

I apologize if this makes your eyes glaze over.

Terms for the Penis

If a penis has been circumcised, there are a number of terms used to describe it. The most common are “circumcised” and “cut.” People who are very against circumcision often use the term “mutilated.” Obviously, that’s intentionally inflammatory and offensive to males who are circumcised. Circumcised men sometimes refer to their penis as “clean” or “clean-cut.” Obviously, that’s offensive to males who are not circumcised. Therefore, I recommend the terms “circumcised” and “cut.”

If a penis has not been circumcised, there are also a number of terms used to describe it. The most common is “uncircumcised.” I’m going to take a slight rabbit trail for a moment. My children are not vaccinated. Anti-vaxxers often take offense at the term “unvaccinated” because, they argue, “you can’t un-vaccinate a child.” To me, this has always demonstrated a profound misunderstanding of the English language. If I am “unlicensed,” that doesn’t necessarily mean I once was licensed but now am not (that would be “de-licensed”). It simply means I am not licensed. The English prefix “un-” simply means “not.” Ergo, “unlicensed” means “not licensed,” “unvaccinated” means “not vaccinated,” and “uncircumcised” means “not circumcised.” So this whole argument doesn’t make any sense to me, but in the same way that anti-vaxxers often take offense at the term “unvaccinated,” people who are opposed to circumcision often take offense at the term “uncircumcised.” My children are not vaccinated and I use the term unvaccinated. I don’t understand the offense at the terms “unvaccinated” or “uncircumcised.” In fact, I think it’s stupid in both situations. But I’m going to respect that opinion by not using the term “uncircumcised” in conversations where people opposed to circumcision might be involved.

Another term for a penis that is not circumcised is “intact.” This is the term those who oppose circumcision most often use. However, it’s insulting to circumcised males because the term was first used in animal husbandry to mean an animal that has not been neutered or castrated. Thus, using the term “intact” for a man who is not circumcised implies that a man who is circumcised has been castrated and/or emasculated. For this reason, some men take offense to the term. In fact, an acquaintance of mine calls himself “intact” even though he’s circumcised. So in conversations with people from both groups, I recommend against the use of the term “intact.” Other terms used include “natural” and “normal,” which are also obviously insulting to circumcised men and intentionally inflammatory; and “anteater,” which is obviously insulting to men who are not circumcised and intentionally inflammatory. The only completely neutral term* I can find that isn’t highly medico-lingal, and which people on both sides use, is “uncut.” So that’s the term I recommend.

Two completely neutral medico-lingal terms are “prepucal” and “aprepucal.” The “prepuce” is the foreskin, so a “prepucal” penis is one that has a prepuce and an “aprepucal” penis is one without a foreskin. However, I thought these terms were too difficult to catch on with non-medical persons.

Therefore, I recommend “circumcised” or “cut” versus “uncut.”

Terms for People

People who support circumcision typically use the terms “pro-circumcision,” “pro-circ,” or “PC.” People opposed to circumcision call them “pro-cutters.” Although the term is technically somewhat neutral, it is always used in a derogatory way, so it’s considered offensive by pro-circs. People opposed to circumcision also call them “pro-mutilators,” “pedophiles,” “child abusers,” “child molesters,” etc. For obvious reasons, I recommend avoiding those terms as well and sticking with “pro-circumcision,” “pro-circ,” or “PC.”

People who oppose circumcision call themselves “intactivists,” which is a combination of “intact” and “activist.” Pro-circs sometimes call them “intactonuts” or “intactic*nts,” which are obviously offensive, so I won’t use those terms. Because the term “intactivist” comes from the offensive use of the word “intact,” it could be argued that “intactivist” shouldn’t be used, either. However, “anti-circumcision activists” is too long and pro-circs most often use the term “intactivist” anyway, so I recommend “intactivist.”

A somewhat neutral term is “PPC” or “pro-parental-choice.” This refers to people who support a parent’s right to choose whether to circumcise, even if they disagree with their choice. Typically, intactivists believe that circumcision is evil and should be completely abolished, so it will be very rare for you to find an intactivist who is also PPC. Therefore, PPC typically only refers to people who are neutral on circumcision or are pro-circ. I have yet to meet a person who actually believes that circumcision should be mandated, but most intactivists believe that circumcision should be legally prohibited.

Conclusion

To help us move toward a better understanding and more fruitful conversations on the topic of circumcision, I recommend the use of emotionally neutral terminology, including “uncut” versus “cut”/”circumcised” and “intactivist” versus “pro-circ”/”PC.” You don’t advance your cause by insulting the other side, and anyone can see that you’re being a jerk. If you really care about helping boys to live healthier, fuller lives, you should consider reaching their parents in the most effective way possible.

*Well, I thought it was completely neutral. I’ve seen it used almost exclusively in a positive light. But just today, after writing this but before publishing it, I discovered that there are even people opposed to that term as well. At any rate, it’s still the least offensive term I can find.

Footnote 1

A brand new and exceedingly rare version of this involves removing only the clitoral hood, but this is not a traditional practice [1]. Because removing only the hood is similar to removing only the foreskin in the man, it is accurate to call it “female circumcision.” However, this is distinct from the practice of FGM, which has never traditionally involved only the hood but rather has always involved some degree of harm to the clitoris and almost always removal of some portion of the labia minora. Some may argue that female circumcision can also be performed for genuine medical reasons such as the treatment of clitoral phimosis [2]. However, in that case, if you read the entire study, you’ll find that the treatment involves cutting a slit in the hood, not removing the entire clitoral hood. Therefore, the only accurate use of the term “female circumcision” is in reference to a new, rare practice that is most common in Egypt and is only one small part of traditional FGM.

Footnote 2

From Reference [1]:

“The language used to describe these practices remains controversial and requires careful ethical consideration. The term ‘Female Genital Mutilation,’ formerly adopted by the United Nations (UN) calls attention to the gravity of the harm caused by FGC practices. ‘Female Genital Mutilation (FGM)’ is the terminology used within campaigns to end these practices by anti-FGC advocates from practicing countries of origin and the western world. FGM terminology positions the practice of FGC as an extreme human rights violation. This term is often perceived as inflammatory, judgemental and stigmatising, particularly for women previously exposed to the practice who do not view their bodies, or the bodies of their daughters, as mutilated [3]. The implication within this terminology is that FGC is practiced as an act of intentional violence against female children, adolescents and women. Those who do not understand FGC as such an act, but as a valued cultural tradition, may experience the language of “mutilation” as alienating [7,9–11]. The delicate challenge of reconciling respect for cultural values associated with these practices and addressing their perceived harmful effects on health is evident in this discrepancy between the intent and impact of language.

” ‘Traditional women’s practices,’ ‘Traditional health practices,’ and ‘Initiation,’ are some of the preferred terms identified by individuals who subscribe to the socio-cultural benefits from these practices. Chalmers & Omer Hashi [10] as well as Vissandjée et al. [7] conducted focus groups with overall 600 women from different practising countries living in Canada which revealed “circumcision” to often be the preferred terminology. Several other authors have also identified “circumcision” as an alternative term, yet this term has been argued to trivialise the procedure, falsely attributing to FGC the legitimacy afforded to male circumcision within the West [12,13]. “Female Genital Cutting (FGC)” and “excision and infibulation” have been identified as more neutral, ethically sensitive terminology [4,6]. For the purpose of this chapter, we will use FGC as a term comprising procedures which alter the female genital organs for cultural or non-therapeutic reasons.”